Healthcare Provider Details

I. General information

NPI: 1386924298
Provider Name (Legal Business Name): GEORGE EL-BAHRI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 KENNERLY RD STE 101
JACKSONVILLE FL
32216-4376
US

IV. Provider business mailing address

6100 KENNERLY RD STE 101
JACKSONVILLE FL
32216-4376
US

V. Phone/Fax

Practice location:
  • Phone: 904-739-0050
  • Fax:
Mailing address:
  • Phone: 904-739-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS11856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: